Modified dengue severity classification, PAHO/WHO
Dengue ...
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Description

Modified dengue severity classification, PAHO/WHO

Dengue without warning signs - DNWS:

 • Person who lives or has traveled to areas with dengue transmission in the last 14 days and presents fever, usually of 2 to 7 days duration, and at least 2 of the following criteria:

     1 . Nausea/ vomiting

     2. Exanthema

     3. Headache/ retro-orbital  pain

     4. Myalgia and arthralgia

     5. Petechiae or positive tourniquet test

     6. Leukopenia

 • Cases also include any child coming from or living in an area with dengue transmission, with acute febrile illness, usually of 2 to 7 days and no apparent focus. 

Dengue with warning signs - DWWS:

 • Every dengue case that, near and preferably at defervescence, presents one or more of the following signs:

     1. Intense abdominal pain or tenderness

     2. Persistent vomiting

     3. Fluid accumulation (ascites, pleural effusion, pericardial effusion)

     4. Mucosal bleed

     5. Lethargy/ restlessness

     6. Postural hypotension (lipothymia)

     7. Liver enlargement >2 cm

     8. Progressive increase in hematocrit

Severe dengue - SD:

 • Every dengue case that has one or more of the following manifestations:

     1. Shock or respiratory distress due to severe plasma leakage. Shock evidenced by: weak or undetectable pulse, tachycardia, cold extremities, and capillary perfusion >2 seconds, pulse pressure 20 mmHg: hypotension in late phase.

     2. Severe bleeding: based on evaluation by the attending physician (e.g. hematemesis, melena, ample metrorrhagia, central nervous system [CNS] bleeding)

     3. Severe organ involvement, such as liver impairment (AST or ALT > 1000 IU), CNS (impaired mental state), heart (myocarditis), or other organs



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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